Provider Demographics
NPI:1063506418
Name:FERRARI, ANGELA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FERRARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EAST ALMA STREET
Mailing Address - Street 2:
Mailing Address - City:MT. SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2343
Mailing Address - Country:US
Mailing Address - Phone:530-918-9522
Mailing Address - Fax:530-918-9526
Practice Address - Street 1:301 EAST ALMA STREET
Practice Address - Street 2:
Practice Address - City:MT. SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2343
Practice Address - Country:US
Practice Address - Phone:530-918-9522
Practice Address - Fax:530-918-9526
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist